title: The importance of cystoscopy and bladder biopsy in women with refractory overactive bladder: the urogynaecologist's point of view?
abstract: OBJECTIVE
  To assess the sensitivity, specificity, positive and negative predictive value of cystoscopy and the clinical value of bladder biopsy in women with refractory overactive bladder (OAB) symptoms.
  
  
  METHODS
  Prospective observational study carried out in a tertiary referral urogynaecology unit in London. Consecutive women with OAB resistant to pharmacotherapy who underwent cystoscopy, hydrodistention and bladder biopsy were studied. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of cystoscopy as well as histological findings for chronic cystitis were evaluated.
  
  
  RESULTS
  106 women aged 22-91 years were studied. Histopathology showed chronic cystitis in 94 women, follicular cystitis 3, acute and chronic cystitis in 2, transitional cell carcinoma in 6 and no abnormality in 1 woman. Trabeculations and increased vascularity were the most common cystoscopic findings, seen in 71% and 72% of women respectively. Haemorrhages on first filling and haemorrhages on refilling had specificities of 86.6% and 80% respectively for chronic cystitis. Their sensitivities were 9.8% and 13.1% respectively. Trabeculations and increased vascularity had sensitivities of 68.1% and 68.1% and their specificities were 11.6% and 4.5% respectively. Trabeculations, increased vascularity, haemorrhages on first filling and haemorrhages on refilling all had a PPV over 80% for chronic cystitis.
  
  
  CONCLUSIONS
  More than 90% of women with refractory OAB symptoms have chronic cystitis on histopathology. Cystoscopy alone is useful, but not always adequate to diagnose chronic cystitis. Antibiotic therapy in those women might be beneficial before starting anticholinergics. Larger randomised controlled trials are mandatory to confirm our hypothesis.
authors.affiliation: Department of Urogynaecology, St. Mary's Hospital, Imperial College NHS Trust, London, United Kingdom. a.digesualex@imperial.ac.uk
authors.forename: G Alessandro
authors.initials: GA
authors.lastname: Digesu
authors.forename: Peter
authors.initials: P
authors.lastname: Sadeghi
authors.forename: Peter
authors.initials: P
authors.lastname: Sadenghi
authors.forename: Sunita
authors.initials: S
authors.lastname: Sharma
authors.forename: Federica
authors.initials: F
authors.lastname: Puccini
authors.forename: Andrea
authors.initials: A
authors.lastname: Tubaro
authors.forename: Ruwan
authors.initials: R
authors.lastname: Fernando
authors.forename: Vik
authors.initials: V
authors.lastname: Khullar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D003556:Cystitis / Q000150:complications; D003558:Cystoscopy; D005260:Female; D006801:Humans; D008875:Middle Aged; D064887:Observational Studies as Topic; D011237:Predictive Value of Tests; D017211:Treatment Failure; D001743:Urinary Bladder / Q000473:pathology*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D055815:Young Adult
chemical_list: D018680:Cholinergic Antagonists
keywords: Bladder biopsy; Cystitis; Cystoscopy; Diagnostic accuracy; Overactive bladder symptoms; Sensitivity; Specificity